Basic Information
| Provider Information | |||||||||
| NPI: | 1396988754 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ANDO | ||||||||
| FirstName: | REBECCA | ||||||||
| MiddleName: | BEDINGFIELD | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | BEDINGFIELD | ||||||||
| OtherFirstName: | REBECCA | ||||||||
| OtherMiddleName: | JAYNE | ||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | MD | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | PO BOX 658 | ||||||||
| Address2: | |||||||||
| City: | GAINESVILLE | ||||||||
| State: | GA | ||||||||
| PostalCode: | 305030658 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7707181122 | ||||||||
| FaxNumber: | 7705357445 | ||||||||
| Practice Location | |||||||||
| Address1: | 725 JESSE JEWELL PKWY SE | ||||||||
| Address2: | |||||||||
| City: | GAINESVILLE | ||||||||
| State: | GA | ||||||||
| PostalCode: | 305013834 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7702972200 | ||||||||
| FaxNumber: | 7705348139 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/15/2009 | ||||||||
| LastUpdateDate: | 02/26/2019 | ||||||||
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| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
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| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207V00000X | 073898 | GA | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 003170305C | 05 | GA | MEDICAID | 1176583 | 01 | GA | WELLCARE | OTHER | 999999 | 01 | GA | BCBS | OTHER | 003170305F | 05 | GA | MEDICAID | 003170305E | 05 | GA | MEDICAID | 035382023 | 01 | GA | AMERIGROUP | OTHER | 99999 | 01 | GA | UNITEDHEALTHCARE | OTHER | 99999 | 01 | GA | TRICARE | OTHER | 003170305G | 05 | GA | MEDICAID | 99999 | 01 | GA | HUMANA | OTHER | 999999 | 01 | GA | CIGNA | OTHER | 003170305B | 05 | GA | MEDICAID | 99999 | 01 | GA | PEACH STATE | OTHER | 999999 | 01 | GA | MULTIPLAN | OTHER | 003170305A | 05 | GA | MEDICAID | 003170305D | 05 | GA | MEDICAID | 999999 | 01 | GA | AETNA & COVENTRY | OTHER |